Tag Archives: metabolism

A new endocrynologist . . .

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Today I had my first appointment with a new endocrinologist.  I was looking forward to it, and dreading it at the same time.  I’ve only been seeing a family doctor for 1.5 years, since moving away from Chicago, and he’s pretty clueless about diabetes, so I really need to find an endo.   The only problem with finding an endo, is that I live far away from any major medical facility, so the selection is basically 3 to choose from with my insurance.  My cousin works in the ER in one of the local small town hospitals though, and she says everybody in this region goes to this 1 endo.  Says he’s great, and everybody loves him.  I also met a diabetes educator at the diabetes walk earlier this year that I liked, and she works for that same endo, so that’s who I chose.  It’s the educator I want to talk to, but first I have to meet with the doctor before she’s allowed to talk to me.  She literally told me, not to worry about what the doctor says about my nutrition, because she’s gonna change it anyway.  We both smiled when she said that.  Just as in Chicago though, he’s so booked, it took 2 months to get in.

The family doctor is great because he just writes my scripts when I ask him too, and I don’t have to go back every 3 months for renewals.  When I moved here, I told him I wanted 1 year renewals for everything, and he did it.  When I was stricken with  a major illness over the summer, I got an appointment that next day, so I could get antibiotics.  You can’t do that in Chicago.

Anyway, I get to the appointment as soon as the office was open.  2 other people in the office.  I was told I had the first appointment when I made it 2 months ago.  Hmmmm?  The first guy didn’t go in until half an hour later, so I’m already not liking what I’m seeing.  The nurse weighs me, walks me into room, sits me down.  Reviews paperwork, asks me questions, tells me she’s going to take an A1C and lipid profile . . . right now.  I tell her that no one told me to “fast”, and she said it won’t matter much, and started reaching for my arm.  I jerked my arm away and said I’m not going to have a blood test taken if it’s not going to be accurate.  That it’s stupid to do something like that.  She left the room as if to tell on me.  Came back and said “ok”.  Then she took the paperwork and the needle, and didn’t even check my vitals.   *sigh*  Now I’m getting pissed.  (You have the right to disagree with your doctors, and stand your ground.  It’s YOUR HEALTH, and YOUR MONEY.)

A few minutes later the doctor walks in.  (No wait.  I wonder if that’s because of my behavior?)  He’s happy and smiling, but difficult to understand.  *sigh*  Foreign accent.  He is however, being very agreeable and friendly, and I begin to like him.  He questions me, reviews my pump settings, my blood sugars.  I ask him why when I was eating low carb, it caused DKA for the first time in my life.  Instead of answering my question, he immediately gets very serious and says no one should ever eat low carb because it causes ketosis.  (At least he got that right, instead of saying it causes ketoacidosis.)  Then however, he told me that the brain cannot function without carbs.  I tried to correct him and said that ketones make the brain function just fine.  He just disregarded what I said and repeated himself.  *sigh*  Then he told me I should be eating 100-120g carbs per meal, 3 times a day, with a 50g snack at night.  *SIGH*  I told him there’s no way that’s going to happen, and that I “might” get 100 – 120 carbs in a whole day.  (Every type 1 diabetic knows this is crazy.  That’s 1600 calories, with no fat or protein yet!)  He knew I would not budge and then changed his tune.  Told me that I could do that, and see how it works.  (Can you see the look on my face right now?)  So then we chit chatted, and he ordered my A1C, lipid profile, thyroid function, and protein test.  Then he arranged an appointment with the educator for 1 week from now.

Doctors.  Geez.  I actually like him though.  He’s very smiley.  I’ll just filter what he tells me.  Why can’t I find a doctor like Richard Bernstein?  I wonder where he lives?  Maybe I should move there?

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Type 1 Diabetic: Insulin vs. Glucagon

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So I’ve been studying the role of glucagon in metabolism.  I’ve never really known anything about glucagon, except that when I was a juvenile diabetic, I’d have seizures from low blood sugar, and when I saw my parents coming at me with that weird syringe, I knew it was glucagon.  They never understood that I was totally conscious during my seizures.  So anyway, I always thought glucagon was a form of ultra pure glucose or something, until I read Robb Wolf’s book “The Paleo Solution” back in March of this year.  He barely touched on glucagon, but did mention that it was a hormone, so I knew it wasn’t a form of sugar.

Well now I understand a great deal more about glucagon.  Been studying like a madman.  I understand that it’s insulin’s sister hormone, that they both come from Islets of Langerhans in the pancreas.  Glucagon comes from alpha cells, and insulin from beta cells.  That together, they are the core of metabolism.  A perfect feedback system that regulates energy in your body.  Glucagon is the yin, to insulin’s yang.  Glucagon releases fat to be burned, where insulin stores it for energy later.  Glucagon raises low blood sugar by signalling the liver to convert stored glycogen into glucose via glyconeogenesis.  When blood sugar rises to high, insulin is secreted to store that glucose as glycogen in muscle tissue, or as fat.  When there’s insulin, you can’t burn fat.  When there’s glycogen, you can’t store fat.  Insulin is secreted when you eat carbohydrates.  Glycogen is secreted when you eat protein.

Ok, so I have the basic understanding I think?  Now, as a T1D how does glucagon work inside me, since it doesn’t work at all inside me?  I can’t find these answers yet?  I’m dying to figure this out.  I know how insulin works in a T1D.  I just take it externally.  T1D’s don’t take glucagon externally except in emergencies though, to raise blood sugar quickly.  In a T1D, those Islets of Langerhans are broken, so neither insulin nor glucagon is secreted.  When a T1D’s blood sugar falls, glucagon doesn’t bring us back up like it does in a normal person.  Haven’t you ever seen a diabetic that’s hypoglycemic?  We don’t know our own name or where we are sometimes!  So if our bodies don’t secrete glucagon, how do we burn fat?  I know we as T1D’s need to take external glucose to raise blood sugar.  Does epinepherine work in a T1D for releasing fat to be burned?  If I understand epinepherine (it’s totally possible that I don’t understand anything about all this), it can function similarly to glucagon in the release of fat for energy.  I know that T1D’s can burn fat, because I’ve done it,  but how if glucagon doesn’t work?

If anyone reading this, can explain how a T1D burns fat for energy without a working glucagon system, I would be eternally grateful.  I know I’m trying to understand something  that’s probably a whole course of material, but I’d really like to understand this.  I’m such a health nerd.

Thanks for any help you can offer.

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